Causes of Vomiting with Diarrhea

Viral Gastroenteritis. GI infection from a virus is the most common cause. A common agent is the Rotavirus. The illness starts with vomiting. Watery loose stools follow within 12-24 hours. On cruise ship outbreaks, the most common viral cause is Norovirus.

Food Poisoning. This causes rapid vomiting and diarrhea within hours after eating the bad food. Caused by toxins from germs growing in foods left out too long. An example is Staph toxin in egg salad.

Traveler's Diarrhea. Caused by germs in food or drink. Suspect this if it follows recent foreign travel.

Bacterial GI Infection. Diarrhea can also be caused by some bacteria. Most bacterial diarrhea goes away on its own. A few can cause a severe large bowel infection (such as Shigella colitis).

Serious Complication: Dehydration. This is the health problem where the body has lost too much fluid. (See below for more on this).

Vomiting Scale

Mild: 1 - 2 times/day

Moderate: 3 - 7 times/day

Severe: Vomits everything, nearly everything or 8 or more times per day

Severity relates even more to how long the vomiting goes on for. At the start of the illness, it's common to vomit everything. This can last for 3 or 4 hours. Children then often become stable and change to mild vomiting.

The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.

Dehydration: How to Know

Dehydration means that the body has lost too much fluid. This can happen with vomiting and/or diarrhea. A weight loss of more than 3% is needed. Mild diarrhea or mild vomiting does not cause this. Neither does a small decrease in fluid intake.

Vomiting with watery diarrhea is the most common cause of dehydration.

Dehydration is a reason to see a doctor right away.

These are signs of dehydration:

Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw colored, your child is not dehydrated.

Dry tongue and inside of the mouth. Dry lips are not helpful.

Dry eyes with decreased or absent tears

In babies, a sunken soft spot

Slow blood refill test: Longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.

Fussy, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.

A child with severe dehydration becomes too weak to stand. They can also be very dizzy when trying to stand.

When to Call for Vomiting With Diarrhea

When to Call for Vomiting With Diarrhea

Call 911 Now

Can't wake up

Not moving or too weak to stand

You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.

Blood in the stool

Stomach pain when not vomiting. Exception: stomach pain or crying just before vomiting is quite common.

Age less than 12 weeks old with vomiting 2 or more times. Exception: normal spitting up.

Age less than 12 months old and vomited Pedialyte 3 or more times

Severe vomiting (vomits everything) for more than 8 hours while getting clear fluids

After 4 hours without throwing up, return to regular feeding at the breast. Start with small feedings of 5 minutes every 30 minutes. As your baby keeps down the smaller amounts, slowly give more.

Older Children (over 1 Year Old), Offer Small Amounts of ORS For 8 Hours:

ORS. Vomiting with watery diarrhea needs ORS (such as Pedialyte). If refuses ORS, use half-strength Gatorade. Make it by mixing equal amounts of Gatorade and water.

The key to success is giving small amounts of fluid. Offer 2-3 teaspoons (10-15 mL) every 5 minutes. Older kids can just slowly sip ORS.

After 4 hours without throwing up, increase the amount.

After 8 hours without throwing up, go back to regular fluids.

Avoid fruit juices and soft drinks. They make diarrhea worse.

Stop All Solid Foods:

Avoid all solid foods and baby foods in kids who are vomiting.

After 8 hours without throwing up, gradually add them back.

Start with starchy foods that are easy to digest. Examples are cereals, crackers and bread.

Do Not Give Medicines:

Stop using any drug that is over-the-counter for 8 hours. Reason: Some of these can make vomiting worse.

Fever: Mild fevers don't need to be treated with any drugs. For higher fevers, you can use an acetaminophen suppository (such as FeverAll). This is a form of the drug you put in the rectum (bottom). Ask a pharmacist for help finding this product. Do not use ibuprofen. It can upset the stomach.

Call your doctor if: Your child vomits a drug ordered by your doctor.

Return to School:

Your child can return to school after the vomiting and fever are gone.

What to Expect:

For the first 3 or 4 hours, your child may vomit everything. Then the stomach settles down.

Moderate vomiting usually stops in 12 to 24 hours.

Mild vomiting (1-2 times per day) with diarrhea may last a little longer. It can continue off and on for up to a week.

Call Your Doctor If:

Vomits all clear fluids for more than 8 hours

Vomiting lasts more than 24 hours

Blood or bile (green color) in the vomit

Stomach ache present when not vomiting

Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)

Diarrhea becomes severe

You think your child needs to be seen

Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.